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Child Health > Resp > Flashcards

Resp Flashcards

1
Q

In older children, is viral or bacterial pneumonia more common?

A

bacterial (viral in younger children)

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2
Q

Common pathogens causing pneumonia in newborn

A
  • Group B streptococcus
  • Gram -ve enterococci and bacilli
    (Organisms from mother’s genital tract)
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3
Q

Common pathogens causing pneumonia in infants & young children

A
  • most common = respiratory viruses (esp RSV)
  • bacterial: Streptococcus pneumoniae, H. influenzae
  • Bordetella pertussis and Chlamydia trachomatis
  • infrequent but srs: Staph Aureus
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4
Q

Common pathogens causing pneumonia in children over 5

A
  • Mycoplasma pneumoniae
  • Streptococcus pneumoniae
  • Chlamydia pneumoniae
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5
Q

At all ages, ___ should be considered as cause of pneumonia

A

Mycobacterium tuberculosis

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6
Q

Marked reduction in incidence of pneumoniae from __ since introduction of Hib immunisation

A

Haemophilus influenzae

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7
Q

A polysaccharide conjugate vaccine, w/ immunogenicity against 13 serotypes of ___ responsible for invasive disease is now included in the routine immunisation schedule in the UK

A

Streptococcus pneumoniae

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8
Q

Presenting symptoms of pneumonia (3 common+ 3 other + 2 atypical)

A

Common:

  • fever
  • cough
  • rapid breathing

Others:

  • lethargy, poor feeding, ‘unwell’ child
  • *consider pneumonia in children w/ neck stiffness or acute abdominal pain
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9
Q

Examination findings of pneumonia

crackles: describe

A
  • tachypnoea (rapid breathing)
  • nasal flaring
  • chest indrawing
  • may have end-inspiratory coarse crackles over affected area
  • classic signs of consolidation w/ dullness on percussion, decreased breath sounds and bronchial breathing over the affected area are often ABSENT in young children
  • oxygen sat. may be decreased
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10
Q

Increased respiratory rate: most sensitive clinical sign for asthma or pneumonia?

A

pneumonia

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11
Q

Silent pneumonia:

A

pneumonia missed when RR not measured in a febrile child

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12
Q

To confirm diagnosis of pneumonia:

A

chest X-ray, but cannot differentiate between bacterial and viral

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13
Q

Which tests are helpful/unhelpful in differentiating viral and bacterial pneumonia in younger children:

A

Helpful: nasopharyngeal aspirate may identify viral causes

Unhelpful: blood tests including FBC and acute-phase reactants

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14
Q

What does blunting of the costophrenic angle on chest X-ray signify in a child w/ pneumonia, and what can it lead to?

A

pleural effusion (associated w/ pneumonia in a small proportion of children)

-may develop into empyema and fibrin strands may form, leading to septations

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15
Q

How is most pneumonia in childhood managed? What are the indications for admission?

A

-most affected children managed at home

Indications for admission:

  • oxygen saturation <92%
  • recurrent apnoea (temp cessation of breathing esp during sleep)
  • grunting and/or inability to maintain adequate fluid/feed intake
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16
Q

General supportive care for pneumonia:

A
  • oxygen for hypoxia
  • analgesia there is pain
  • IV fluids if dehydrated, to maintain adequate hydration and sodium balance
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17
Q

Choice of antibiotic for pneumonia in:

  • Newborns
  • Older infants
  • Children over 5 years
A

Newborn - broad-spectrum IV antibiotics

Most older infants - oral amoxicillin
Complicated or unresponsive - broader-spectrum such as co-amoxiclav

Children over 5 - amoxicillin or an oral macrolide (e.g. erythromycin)

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18
Q

Is IV or oral treatment better in mild/moderate pneumonia?

A

No evidence of either being more advantageous

19
Q

___ occur in up to 1/3 of children w/ pneumonia and may resolve w/ antibiotics, but persistent fever despite 48 hrs of abx suggests a ___

A

Small parapneumonic effusions

Pleural collection (requires drainage w/ USS guidance)

20
Q

Typical CXR of a right middle lobe consolidation:

A

normal right hemidiaphragm but partial loss of the R heart border

21
Q

Follow-up of pneumonia for children w/:

  1. Simple consolidation on CXR and who recover clinically
  2. Evidence of lobar collapse or atelectasis

Prognosis: recovery %?

A
  1. not required
  2. repeat CXR after 4-6 weeks to check if lung fields normal

-virtually all children w/ pneumonia make full recovery

22
Q

Pneumonia: Differentials

A

Head and neck disorders:

  • Otitis Media
  • Rhinorrhea
  • Nasal Polyps
  • Pharyngitis
  • Upper Respiratory Infection

Respiratory conditions

  • Acute respiratory distress syndrome
  • Asthma
  • Bronchiolitis
  • Bronchitis
23
Q

Most common serious respiratory infection of infancy:

A

bronchiolitis

Babies Bronchiolitis, Children Croup

24
Q

Bronchiolitis definition:

__ is pathogen in 80% of bronchiolitis, remainder are accounted for by:

A
  • acute inflammatory injury of the bronchioles that is usually caused by a viral infection
  • RSV
  • parainfluenza virus, rhinovirus, adenovirus, influenza virus, human metapneumovirus
25
Q

Bronchiolitis symptoms:

A

-first coryzal symptoms: cough, sneeze, sore throat, loss of smell, nasal congestion
Then:
-dry cough
-increasing breathlessness (feeding difficulty associated w/ this)

26
Q

Population most at risk of severe bronchiolitis:

A

Infants born prematurely who:

  • develop bronchopulmonary dysplasia
  • have other underlying lung disease (e.g. cystic fibrosis)
  • have congenital heart disease
27
Q

Bronchiolitis examination findings:

A
  • dry wheezy cough
  • cynosis or pallor
  • tachypnoea and tachycardia
  • subcostal and intercostal recession
  • hyperinflation of chest: sternum prominent, liver displaced downwards
  • fine end-inspiratory crackles (crepitations)
  • high-pitched wheezes - expiratory > inspiratory
28
Q

Bronchiolitis complications:

A
  • Recurrent apnoea is a serious complication, esp in young infants
  • cyanosis due to lack of oxygen
  • dehydration
  • low oxygen lvls and resp failure
  • Feeding diffulty from increased dyspnoea
29
Q

Bronchiolitis investigations:

A
  • pulse oximetry performed on all children w/ suspected bronchiolitis
  • no other investigations routinely recommended; CXR and blood gases only indicated if resp failure suspected
30
Q

Causes of acute respiratory distress in an infant (9)

A 
Bronchiolitis
Viral episodic wheeze
Pneumonia
Heart failure
Foreign body
Anaphylaxis
Pneumothorax or pleural effusion
Metabolic acidosis
Severe anaemia
31
Q

Bronchiolitis: hospital admission indicated if (4):

A
  • apnoea (observed/reported)
  • persistent oxygen sat of < 90% when breathing air
  • inadequate oral fluid intake (50-75% of usual vol)
  • severe respiratory distress - grunting, marked chest recession, or an RR over 70 breaths per min.
32
Q

What indicates severe respiratory distress (3)?

A
  • grunting
  • marked chest recession
  • or an RR over 70 breaths per min.
33
Q

Management of bronchiolitis:

A

supportive.

  • humidified oxygen via nasal cannulae or head box
  • monitored for apnoea
  • Fluids via NG tube or IV
  • Assisted ventilation in the form of non-invasive support w/ CPAP, or else mechanical ventilation required in small % of infants
  • RSV highly infectious: infectious control measures

-no evidence for use of mist, nebulised hypertonic saline, antibiotics, corticosteroids or neb bronchodilators

34
Q

Bronchiolitis prognosis:

A

most infants recover from acute infection < 2 weeks. However, as many as 50% will have recurrent episodes of cough and wheeze

35
Q

Rarely, bronchiolitis may result in permanent damage to the airways (____), usually following __ infection

A

bronchioliitis obliterans

Adenovirus

36
Q

Prevention of bronchiolitis + method of administration:

A

A monoclonal antibody to RSV (palivizumab, given monthly by IM injection)
-limited by cost and need for multiple injections

37
Q

Definition of croup:

A
  • AKA laryngotracheobronchitis
  • respiratory infection usually caused by a virus
  • leads to swelling inside trachea -> interferes w/ normal breathing
38
Q

Classic symptoms of croup:

A
  • “barking” cough, like a sea lion, due to tracheal oedema and collapse
  • stridor
  • hoarse voice due to inflammation of the vocal cords
39
Q

Most common viral cause of croup

+ other causes

A
  • Parainfluenza virus

- rhinovirus, RSV, influenza

40
Q

Croup age range + peak incidence

A

Typically occurs from 6 months-6 years

Peak incidence = 2 years

41
Q

Season w/ highest incidence of croup?

A

Autumn

42
Q

Other symptoms of croup:

A
  • starts with typical coryza and fever

- variable degree of difficulty breathing w/ chest retraction

43
Q

When symptoms appear in croup, when are they the worst?

A

Symptoms often start, and are worse, at night

Child Health (1 decks)

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